Help for Mental Health & Substance Abuse Clients in Western North Carolina

A new crisis center for mental health patients in five North Carolina mountain counties will work to relieve the pressure on emergency departments.

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One day this June, Wilkes County Sheriff Chris Shew found 22 patients with mental health and substance abuse problems crowding the local hospital’s emergency department, waiting for treatment, transportation or other help.

For Shew, the pileup required his department to provide a deputy around the clock due to the presence of people under voluntary or involuntary commitment at the Wilkes Regional Medical Center.

All too often, patients in need of psychiatric services end up in local hospital emergency departments, because there’s no where else to get services. Image courtesy KOMU News, flickr creative commons

This situation has played out frequently across North Carolina in recent years, but a partial solution is coming within the next year for people in mostly rural Wilkes, Ashe, Alleghany, Watauga and Avery counties. Daymark Enterprises, a service provider contracting with the Smoky Mountain LME-MCO, will open a 16-bed facility-based crisis center in North Wilkesboro.

“Here’s the beauty of these things,” said Billy West, CEO of Daymark, which already operates a 8 a.m.-5 p.m. crisis center in North Wilkesboro. “In our other facilities, the sheriff has to take someone to Broughton [state psychiatric hospital], and when they are released, the sheriff has to come back and get them.”

West said Kannapolis-based Daymark has similar facility-based crisis centers in Monroe, Concord and Statesville and plans one in Lexington in addition to the North Wilkesboro site. In counties without this capacity, law enforcement bears much of the burden of dealing with behavioral health clients when residential and community placements are maxed out.

“We provide care primarily through our Advanced Access Clinics, also known as walk-in centers, where we can provide on-demand care and a host of evidenced-based treatments,” West said. “We have over 60 psychiatrists that are linked together across all our 42 locations through telemedicine.”

Sherry Foreman is a spokeswoman for the Smoky Mountain LME-MCO, which manages Medicaid, state and local funds for people who need mental health, substance abuse or developmental disabilities services. The LME-MCO has identified a need for for crisis stabilization units in these communities, she said, because many clients can receive help that would avoid them a hospital stay — and potentially a long wait in an emergency department.

In a 2013 report by the Centers for Disease Control and Prevention, researchers found that North Carolina emergency department visits by people with mental health diagnoses increased by 17.7 percent during a two-year period. The incidence of these admissions among older people was markedly higher, with people older than 65 making up more than half of the adults admitted.

Overall, the highest proportion of emergency departments’ mental-health admissions by diagnosis was 60 percent, for people with dementia. The counties covered by the new Daymark facility, with the exception of Watauga, have average ages from five to eight years older than the state average.

Daymark places a priority on making sure that clients return for follow-up care and about 90 percent do so. The follow-up can be with Daymark or another provider.

“Most people do follow up directly with us, others do not, and that’s OK,” West said. “We’ll
send you back to your own provider. There’s a big continuity of care.”

Foreman, representing Smoky Mountain, told Wilkes County commissioners that the facility-based crisis center will supply full-time jobs with benefits for more than 20 people.

“By this time next year we hope to have this open,” West said. “It has taken time to get this far to pick a county, pick a location, pick a model. We are very experienced in opening new facilities up, especially this type of facility.”

According to West, the new center will add round-the-clock capacity to its existing facility, which already provides walk-in care, mental health and substance abuse outpatient treatment, school-based services, and a psychosocial rehabilitation program.